Addressing Health Disparities Among Incarcerated and Recently Incarcerated

Addressing Health Disparities Among Incarcerated and Recently Incarcerated Populations March 24, 2015

Webinar Presenters n Harold Phillips, MRP, Director, Division of Training and Capacity Development at HRSA/HAB n Adan Cajina, MS, Chief, Special Projects of National Significance Branch at HRSA/HAB n Melinda Tinsley, MA, Public Health Analyst, Special Projects of National Significance Branch at HRSA/HAB n Sarah Cook-Raymond, MA, Managing Director, Impact Marketing + Communications on the Integrating HIV Innovative Practices (IHIP) Project n Alison O. Jordan, LCSW, Executive Director, Transitional Health Care Coordination, NYC DOHMH/Correctional Health Services

Learning Objectives n Better understand mission of Division of Training and Capacity Development and SPNS’ role in addressing health disparities n Improved understanding of intersection of HIV, mental health, substance abuse, and other health disparities among incarcerated/recently incarcerated populations n Public health opportunity available within jail setting for addressing HIV-positive high-need individuals n How jail linkage work advances the HIV Care Continuum n Major steps to establishing or expanding a jail linkage program n About the SPNS Enhance. Link jail linkage program, key findings, and case study

Special Projects of National Significance Projects Harold Phillips, MRP Director, Division of Training and Capacity Development Adan Cajina, MS Chief, Special Projects of National Significance Branch Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau

Overview Division of Training and Capacity Development • Mission: Strengthen and transform health care systems by supporting the development of leadership, evaluation, training and capacity development to assure the provision of high quality HIV/AIDS prevention, care and treatment services. 5

Division of Training and Capacity Development (DTCD) Administrative Support Bukeeia Goodson Director Harold Phillips Deputy Director Jose Rafi Morales Chief Medical Officer Philippe Chiliade/Rupali Doshi Senior Policy Advisors Raymond Goldstine (Acting) Jewel Bazilio-Bellegarde Special Projects of National Significance Chief – Adan Cajina Pamela Belton Melinda Tinsley Jessica Xavier Chau Nguyen Natalie Solomon Renetta Boyd Budget Management Terri Newman Global Health Systems Chief – George Tidwell Susan Becker John Hannay Richard Poole Philippe Chiliade Janette Yu-Shears Ellen Caldeira John Oguntomilade Christine Lim Diana Palow HIV Education Branch Acting Chief – Jewel Bazilio. Bellegarde Andrea Knox Dieunita Gamliel Mekeshia Bates

SPNS Program (Part-F) • The SPNS Program supports the development of innovative models of HIV care to quickly respond to the emerging needs of clients served by the Ryan White HIV/AIDS Program. • • Evaluation Dissemination Replication Build and Improve IT capacity

SPNS History • Incorporated as Part F into the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1996 along with the AIDS Education and Training Centers (AETCs) and the Dental Partnership Program • Program began with some of the first federal grants to target adolescents and women living with HIV

SPNS Direction SPNS has been tasked to respond to the emerging HIV primary care needs of individuals receiving assistance under the RWHAP SPNS initiatives have evolved to reflect: • changes in the epidemic • changes in the health care environment • alignment with HIV national policy strategies • Focus on Sustainability, dissemination and replication

The National HIV/AIDS Strategy • Vision statement calls for every person to have unfettered access to high-quality care • National HIV/AIDS Strategy (NHAS) 2015 targets: – Reduce new HIV infections – Increase access to care and improve health outcomes – Reduce HIV-related health disparities

The HIV Care Continuum Source: CDC. HIV surveillance—United States, 1981– 2008. MMWR 2011; 60: 689– 93.

Overview of SPNS Initiatives

Current SPNS Initiatives • System Level Workforce Capacity Building for Integrating HIV Primary Care in Community Health Care Settings (2014 – 2018) • Health Information Technology Capacity Building for Monitoring and Improving Health Outcomes along the HIV Care Continuum Initiative (2014 – 2017) • Culturally Appropriate Interventions of Outreach, Access and Retention among Latino(a) Populations (2013 – 2018) • Enhancing Access to and Retention in Quality HIV Primary Care for Transgender Women of Color (2012 – 2017)

Current SPNS Initiatives (continued) • Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative (2011 – 2016) • Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations (2012 – 2017) • Secretary’s Minority AIDS Initiative Fund (SMAIF) Replication of a Public Health Information Exchange to Support Engagement in HIV Care (2012 – 2015)

Recently Ended SPNS Initiatives • Enhancing Access to and Retention in Quality HIV/AIDS Care for Women of Color (2009 – 2014) • Hepatitis C Treatment Expansion (2010 – 2014) • Secretary’s Minority AIDS Initiative Fund (SMAIF) Retention and Re-Engagement Project (2011 – 2014) • Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012)

Upcoming SPNS Initiatives • Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum (2015 – 2019) • Dissemination of Evidence-Informed Interventions to Improve Health Outcomes along the HIV Care Continuum – Dissemination and Evaluation Center (2015 – 2020) • Dissemination of Evidence-Informed Interventions to Improve Health Outcomes along the HIV Care Continuum – Implementation and Technical Assistance Center (2015 – 2020) • Secretary’s Minority AIDS Initiative Fund (SMAIF) Addressing HIV and Housing through Data Integration to Improve Health Outcomes along the HIV Care Continuum

Overview of Enhance. Link Initiative

Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012) • Design, implement, and evaluate innovative methods for linking people living with HIV/AIDS who are in jail or recently released with HIV primary care and ancillary services • 10 demonstration sites at 20 separate jails • One technical assistance/evaluation center • $21. 7 million over 5 years

Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012)

Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012) Main Findings • 65% of study participants identified as Black • Black participants were more likely to have had advanced HIV • Jails as strategic venues to reach HIV+ Black MSM • 22% of HIV+ Black male study participants were MSM • HIV testing and linkage interventions are needed within jails to reach Black MSM and to address racial disparities

Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012) Main Findings • 59% of Black MSM are not aware of their HIV infection. CDC MMWR 2010; 59(37): 1201 -7. • Young Black MSM constitute a segment of the population. Prejean J, Song R, Hernandez A, et al. Estimated HIV Incidence in the United States. • SPNS’ study highlight the potential of expanded jail testing and linkage may reach ~11% of this underserved population.

Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012) Main Findings • Efforts to ensure care following release from jail are associated with a high degree of viral suppression. • Linkage to care with an HIV provider within 30 days of release is an excellent measure of success. • People who participated in case management were more likely to follow up on care referrals • Coordinating social services was associated with retention in care

Further Information List of SPNS Initiatives http: //hab. hrsa. gov/abouthab/partfspns. html Target Center www. careacttarget. org/category/topics/spns SPNS Products http: //hab. hrsa. gov/abouthab/special/spnsproducts. ht ml

Contact Information Harold Phillips Director, Division of Training and Capacity Development HPhillips@hrsa. gov Adan Cajina Chief, Special Projects of National Significance Branch ACajina@hrsa. gov Melinda Tinsley Public Health Analyst, Special Projects of National Significance Branch MTinsley 1@hrsa. gov www. hab. hrsa. gov/abouthab/partfspns. html 301 -443 -7036

Presented by Sarah Cook-Raymond, Managing Director of www. impactmarketing. com

Introducing IHIP n SPNS launched the “Integrating HIV Innovative Practices” (IHIP) Project n IHIP takes innovative findings from SPNS Initiatives and assists health providers in replicating proven models of care n SPNS project findings are synthesized into IHIP instructional training manuals, curricula, pocket guides, and webinar series n The result? Improved care delivery and healthier patients

IHIP on HAB Website: You can navigate straight to SPNS IHIP products from the HAB site or head directly to the TARGET Center site Products from SPNS Initiatives HAB Homepage

IHIP Resources on TARGET Center Website www. careacttarget. org/ihip

IHIP Resources: Enhancing Linkages to HIV Primary Care in the Jails Setting n Includes lessons learned and step-by-step recommendations on how to implement a new jail linkage program and how to expand a current one. POCKET GUIDE Testimonial: “The curriculum and training guide are everything that we've always wanted in terms of trying to explain, not only to our family and loved ones but to our clients and bosses, what exactly it is that we do and why we do it. And I can't be more thrilled with the product and the way that this will be so useful to us and to others in the field. I'm really excited about it. ” — Alison O. Jordan, Executive Director at NYC Dept. of Health and Mental Hygiene, Correctional Health Services/Transitional Health Care Coordination, Riker’s Island, N. Y. TRAINING MANUAL

Incarceration Overview n While the terms “jails” and “prisons” are often used interchangeably, they represent different kinds of correctional facilities n Approximately solely in jails. 85% of incarcerated people were

Studying a Jail Intervention n Given the number of people living with HIV passing through jail facilities and the need to reach them, SPNS funded the “Enhancing Linkages to HIV Primary Care & Services in Jail Settings Initiative, ” otherwise known as Enhance. Link n Enhance. Link filled an important research void

Why Jails? n Jails concentrate marginalized individuals with range of social and health problems in one place n Many individuals in jail have had fragmented health care services due to co-occurring health conditions and issues that interfere with access (e. g. substance abuse, mental illness) n n Structural inequalities such as poverty and unstable housing also contribute Behaviors that often place individuals at risk for incarceration also place them at risk for STIs, including HIV

Aligns with Federal Priorities n CDC strongly recommends jail-based HIV testing n Routine HIV screening in jails is consistent with NHAC n Jail linkage helps to move individuals along the HIV Care Continuum

Health Disparities among Incarcerated Persons n Higher rates of HIV, viral hepatitis, TB, mental illness, substance abuse n Also more likely to have histories of physical, sexual, and emotional abuse n Jails represent a chance to test, diagnose, and treat high-risk populations and offer an opportunity for marginalized people to interact with the health care system

Enhance. Link n Individuals in jails often return to the same communities in which they came n Enhance. Link showed that while jail stays can be brief and there can be some uncertainty around discharge dates, engagement, testing, and linkage coordination are all feasible within this setting n. A successful jail intervention can decrease expensive ER visits, decrease HIV transmission, reduce recidivism, and improve quality of life

Enhance. Link Patients n Enhance. Link engaged very high-needs patients n 90% knew their HIV status for at least 2 years yet 81% had never taken ART n 66% of participants had uncontrolled viremia (viral load > 400 copies/ml) n Of those previously prescribed ART, only 55% were on HIV medication on the 7 days leading up to incarceration n Only a few participants had a formal mental health diagnosis yet 54% had an Addiction Severity Index (ASI) mental health score of. 22 or greater (indicative of severe psychiatric illness) n Nearly all participants had histories of substance use with 59% with ASI drug scores of at least. 16 (representing severe drug addition)

Enhance. Link Program Steps n Major Enhance. Link components included: n HIV testing or inmate self disclosure, and mental health/substance abuse screenings n Recruitment (including informed consent) and enrollment into the program n Pre-release intensive case management intervention (typically within 24 hours or at least within first 48 hours) and individualized discharge plans n Medical care and HIV education, including risk reduction n Post-release intensive case management linkages

Enhance. Link Effectiveness n Enhance. Link was found to be cost effective from a societal perspective n Having case manager work closely with jail medical staff also helped reduce costs incurred by the jail, creating increased motivation and justification for a partnership n Given short stays of jails, Enhance. Link participants did not identify a substantial increase in pharmacy costs n Coordinated medical records enabled community and jail medical staff to avoid duplicating test and lab work that was already on file

Tips for Establishing a Jail Linkage Program n Before getting started, examine the existing programs and organizations operating with the jail n Consider how you may partner with these organizations n Recognize the different priorities of medical clinics versus jails: one prioritizes health and the other safety. To work effectively in the jail you need to abide by their “home turf” rules n Identify the benefit you’re providing to the jail and to jail personnel n To secure buy-in, target high-level decision makers and do so early so they feel their opinion is valuable n It’s important to identify a champion within the jail early on

Tips (cont. ) n Really think through the logistics of what your program will look like within the jail setting constraints and how you’ll adapt n Outline expectations early on and often n Hire people who understand the correctional culture and really want to be doing this work. n Don’t underestimate the importance of a smile and a thank you—both with jail staff and inmates

If Already in the Jail n Nurture partnerships and facilitate ongoing communication n Consider how you’re assessing patient needs n If there are needs you can’t address, look to partners (e. g. court advocacy) n Create discharge plans, starting with inmates’ basic needs and working to address their priorities as well as your own n Linkages to care aren’t automatic. They need to be active linkages with warm handoffs. n Recognize that home visits in the community to followup with individuals not linked immediately after release will be necessary with some people.

Contact Information n Sarah Cook-Raymond, Managing Director Impact Marketing + Communications scook@impactmarketing. com 202 -588 -0300 www. impactmarketing. com

Linkages and Care Engagement: From NYC Jail to Community Provider Alison O. Jordan LCSW Executive Director, Transitional Health Care Coordination NYC DOHMH / Correctional Health Services Rikers Island, NY AIDS Education and Training Center / National Resource Center Health Disparities Collaborative March 24, 2015

RIKERS ISLAND Vernon C. Bain Center, Bronx Brooklyn Detention Center Manhattan Detention Center Transitional Health Care Coordination

Correctional Health Services (CHS) At A Glance Facilities 12 jails: 9 on Rikers Island (1 female facility, 1 adolescent facility), 3 borough houses, public hospital inpatient unit Average Daily Population 11, 827 Annual Admissions 81, 758 Community Releases 60, 000 / year Length of Stay mean=53 days; median~8 d e. Clinicalworks, customized for jail setting; Electronic Health Record care mgt templates; unidirectional interface (adopted 2008 -2011) with NYC DOC Inmate Information System Sources: NYC Department of Corrections Mayoral Report – 2013 http: //www. nyc. gov/html/doc/downloads/pdf/MMR-FY 2013. pdf Annual releases from NYC DOC Report of Discharges by zip code for CFY’ 14

CHS Background NYC Department of Health and Mental Hygiene oversees health care of inmates in all NYC jails • Goals: Improve the health of incarcerated individuals and community health. • Correctional Health Services oversees medical care in the jails with over 78, 000 medical visits monthly • Medicaid prescreening: 6 k; Medicaid applications: 1, 400 • Discharge Planning – Population-based for mentally ill (13 k); HIVinfected (2. 5 k); others at high risk (1. 5 k) • All jails use electronic health record

Twin Epidemics: Mass Incarceration & HIV Over 70% of people released to the community after incarceration return to the areas of greatest socioeconomic and health disparities Correctional Health is Public Health

Jail Demographics Age ALL Range 16 - 84 Mean 34 HIV Race ALL HIV Non-Hispanic Black (%) 54. 0% 61. 0% Hispanic (%) 33. 0% 30. 0% Non-Hispanic White (%) 8. 7% 7. 0% 41<51 (21. 8%) 41<51 (44. 3%) Gender ALL HIV 51+ Male (%) 89. 0% 78. 3% 16 - 68 45 16<21 (13. 4%) 16<21 (1. 3%) 21<31 (32. 8%) 21<31 (10. 1%) Break 31<41 (21. 6%) 31<41 (18. 6%) down (10. 2%) 51+ (25. 4%) *2011 Correctional Health Services new admission records (N=61, 853)

Prevalence by Diagnosis • Substance abuse: >50% • Mental Illness: 30% • Hepatitis C: 8% • HIV: 5% • Diabetes: 5% • Tuberculosis: 5% • Other Sexually Transmitted Infections: 6%

System Challenges • Solutions Barriers Short-term stays are norm • Intake History and PE • • • universal voluntary < 24 hrs • ongoing offer thereafter ~25% leave in 2 -3 days ~50% leave within 7 days • Limited time to diagnose • Screen on admission • Multiple providers • Single oversight • Limited time to treat, maintain care • Discharge plan asap • Paper records • Electronic Health Records • Post-release tracking • • engage in housing areas • transport / accompaniment Health Information Exchange Removing barriers

Establish & Maintain Relationships • Smile • Listen first • • • Chain of Command – Identify Champions • Shared benefits (reduced – then ask Key Questions violence, improved security) Begin where you can • Prisons v. jails Set realistic goals • Acknowledge extra work Build trust – Start with winnable battles • Be a familiar face • Learn who to approach for: – Deliver jail access, security training Give more than you receive & space to interview clients

HIV Continuum of Care Model Transitional Care Coordination • Opt-in Universal Rapid HIV Testing • Primary care and treatment including appropriate ARVs • Treatment adherence counseling • Health education and risk reduction Jail-based Services • • • Discharge Planning starting on Day 2 of incarceration Health Insurance Assistance / ADAP Health information / liaison to Courts Discharge medications Patient Navigation: accompaniment, home visits, transport, and re-engagement in care • Linkages to primary care, substance abuse and mental health treatment upon release Community-based Services • • HIV Primary Care Medical Case Management Health promotion Patient Navigation: accompaniment, home visits, and re-engagement in care Linkages to Care Treatment adherence and Directly Observed Therapy (DOT), as needed Housing assistance and placement Health Insurance Assistance / ADAP

Transitional Care Services • • Identify population – use electronic health records Engage client – access to housing areas Conduct assessment – universal tool Screen for Benefits – DSS is a partner Arrange discharge medications – 7 days + Rx Coordinate post-release plan – Primary care, social service orgs, Courts, attorneys, treatment providers Facilitate continuity of care • Aftercare letters / transfer medical information using HIE • Make appointments / walk-in arrangements • Arrange transportation / accompaniment

Critical Skills Community Health Workers Probation Parole Health Dept. Courts Staff Health Insurers Hospitals Health providers Funders Correction s

SPNS Jail Linkages Initiative • HRSA Special Projects of National Significance Enhancing Linkages Demonstration Project – Ten site demonstration and evaluation of HIV service delivery in jail settings to develop innovative methods for providing care and treatment to HIV infected individuals in jail settings. • Largest study of those released from jails to date – NYC enrolled 40% of 1, 021 released to the community and followed by case managers. (Booker, 2013)

SPNS Jail Linkages Initiative* Ten Demonstration Sites (2007 -2012) Facilitate linkage to primary care for HIV patients leaving local jails: • Identify HIV patients in custody • Initiate transitional services in jail • Facilitate post-release linkage to primary careofand community *Background slide courtesy Anne Spauding, Emory Univ. services.

Creating a Jail Linkages Program Expect the Unexpected Client Level: – – Begin Where the Client is; harm reduction model. Plan for both options: Stay or Go Program Level: – – – Hire staff who care, clear security, culturally aware, bilingual Train staff: Motivational Interviewing Partner Agreements Systems Level: – – – Track outcomes Arrange transitional services Partner with community health centers; walk-in hours

SPNS Jail Linkages Initiative Local Study Protocols Enrollment: adult HIV patients enrolled during jail stay Exclusion criteria: newly diagnosed, receiving mental health discharge planning, likely to have long sentence (>1 year) Baseline survey: initiated at index incarceration Jail chart review: most recent clinical data at time of release Post Release Services: linkage determined 30 d post-release C 6 M (6 -month follow up): – Followed post release with regular check in and survey at 6 m – Recorded clinical data gathered from clinicians at 6 m

SPNS Jail Linkages Initiative Site Specific Study Design Case Management / Data Collection Program Focus NYC Health Patient Care Coordinators in jails; Community reentry providers’ dually-based transitional counselors PCC and counselors trained by Yale Research and Evaluation Team Population-based approach Linkage to Care within 30 d of release Program Enhancements Health Liaison to the Courts

SPNS Jail Linkages Initiative Disposition of NYC participants 555 Baseline enrollments 488 Included in MSE sample 434 Baseline sample 243 Seen at follow-up 67 Not Released in time for MSE inclusion 54 Dropped: 3 died 10 Moved 41 Prison Return 191 Lost to follow-up

SPNS Jail Linkages Initiative Baseline Medical / Substance Use History Medical / Substance use co-morbidities NYC Baseline n=555 (%) Active / other medical problem Hepatitis C virus Medical Insurance History of Heroin Use 76% 40% 91% 56% History of Methadone Alcohol / drug treatment ever Troubled by Drug use, last 30 d SF-12 Physical Composite Score 39% 23% 66% 47. 5 (SD: 10. 6)

SPNS Jail Linkages Initiative Baseline Socio-Economic Factors Indicator NYC Health n=555 Never completed high school 47% H. S. Diploma / GED 38% Job / skill training Some College + Employed 30 days prior Committed relationship 58% 15% 10% 30% Age <18 years at first arrest 50% Proportion of Lifetime spent incarcerated (mean) 9% Arrests (mean) 26

SPNS Jail Linkages Initiative Services Accessed – 30 days post release Service category accessed 30 days post release NYC % (n=402 ) HIV primary care 71% Other medical care 37% Alcohol/Substance use treatment 52% Housing 32%

Access to Care Strategies non-medical strategies to facilitate access to care • Case conferencing prerelease • Medical summary / medications • Accompaniment / transport • Community case manager • Directly Observed Connections • Patient Navigator / Care Coordinator

SPNS Jail Linkages Outcomes From baseline to 6 month follow-up Indicator NYC Health All Sites Clinical Care CD 4 (mean) ↑ (374 to 412) ↑ (416 to 439) v. L (mean) ↓ (54, 031 to 13, 738) ↓ (39, 642 to 15, 607) Undetectable v. L ↑ (11% to 22% ) ↑ (10% to 21% ) Engagement in Care # Taking ART ↑ (56% to 93%) ↑ (57% to 89%) ART Adherence ↑ (81% to 93%) ↑ (68% to 90%) Average # ED visits p/p ↓ (. 60 to. 20) ↓ (1. 1 to. 59) Basic Needs Homeless ↓ (22. 4% to 4. 15%) ↓ (36. 2% to 19. 2%) Hungry ↓ (20. 7% to 1. 7%) ↓ (37. 4% to 14. 1%)

After Incarceration • Along with primary medical care, Jail Linkages clients were also connected to: – Medical case management (53%) – Substance abuse treatment (52%) – Housing services (29%) – Court advocacy (18%) • Approximately 65% of clients accept the offer of accompaniment and / or transport to their medical appointment. • 85% of those who were not known to be linked to care were found by NYC Home Visit team; finding 30% re-incarcerated. “An ideal community partner offers a ‘one-stop’ model of coordinated care in which primary medical care is linked with medical case management, housing assistance, substance abuse and mental health treatment, and employment and social services. ”

Process Improvements • Improve acceptance of follow up rapid testing – Acceptance rate increased from 30% to 60% • Improve acceptance of service plans – Acceptance rate increased from 85. 4% to 92. 8% • Health Liaison to the Courts – Release rate increased by 20% • SPNS Jail Linkages Program Evaluation – Over 100 followed for 12 months post-release • Integrate with EHR – Case management templates implemented 5/13

Linkage to Care Outcomes 2008 -2012 n=17, 010 self-reported HIV-positive admissions to NYC jails (2008 -2012) 3000 89% 91% 2500 2008 2009 78% 2000 2011 2012 74% 1500 1000 500 0 Offered a Plan Received a Plan 2, 700 2, 456 Released with a Plan 1, 910 Linkage to Primary Care 1, 420

Community Collaborations • NYS Links: enhance and replicate program • NYC Care Coordination, Supportive Housing and Health Home Providers • Linkage agreements / Memorandum of Understanding • SAMHSA ORP pilot collaborations • Bronx Health and Housing Consortium • Health Liaisons to the Courts • NYS Criminal Justice and Health Home workgroup • APHA Jail / Prison Health Committee • Bronx Health Home pilot - linkages under ACA model • SPNS Latino Populations grant – transnational approach • SPNS Workforce Capacity grant – PR replicating model

Health Liaison to the Courts • Health-based court advocacy to facilitate – community alternatives to incarceration including substance use / mental health treatment – compassionate release to skilled nursing / hospice care • Service plan addresses health and service needs of the client while addressing public safety. • Health information, records / letters from MD • Coordinate with prosecutors, courts, defenders, care coordination agencies, community treatment providers, nursing homes, hospice programs and supportive / transitional housing service network

Health Liaison Outcomes • In 2013, 735 received Health Liaison services: – 390 diverted to ATI – 109 placed in non-mandated treatment programs – 113 restored to parole – 82 granted compassionate release – 41 term reduced in the interest of justice. • At least 345 (47%) would have remained incarcerated. • Providing information to the courts improves health outcomes and reduces the impact of incarceration on communities with the greatest health disparities.

Health Home Collaborations • CHS currently receives rosters from 7 NYC-based Health Homes – On average, about 10% of those currently incarcerated in a NYC jail are on one of the health home rosters • CHS is currently partnering with 2 NYC-based Health Homes to actively link those currently incarcerated with their health home care management organization – Bronx Health Home supports a Project Officer and PCC for their assigned patients – South Brooklyn HH outstations two Project Liaisons to coordinate care for their patients receiving MH services

Why Partner with Us? Jail population is: • Sicker and has greater health disparities than general population • More likely to use ED and have resulting hospitalizations CHS has: • Demonstrated, evidence-based approach to linkages to care • Agreements with extensive network of NYC service providers Through our partnerships we can: • Remove barriers to engagement in care • Avoid unproductive outreach • Help patients address basic needs during critical reentry period

Significant Gains Information Dissemination • Papers published in peer-reviewed journals • National and International Conference Presentations • Demonstrated alternatives to incarceration Program Sustainability • Cost saving at a societal level • Additional funding / expansion • Integration with ACA / Health Homes Program Expansion • Health Liaisons to the Courts • Improve access and engagement in care Further Evaluation • Women, Transwomen, Puerto Rican origin • Workforce Capacity; replication in PR VALUE ADDED

SPNS Collaborations Inform and inspire: Best practices Cost analysis Cross site visits & presentations New friends Marry Creative Ideas & Practical Solutions to Wicked Problems Ancillary cost benefit far exceeds grant awards!

On-line Resources http: //www. careacttarget. org/ihip Creating a Jail Linkages Program Training Manual & Curriculum Webinar Series http: //link. springer. com/search? query=enhancelink [Journal of AIDS and Behavior Supplement 2 September 27, 2013] http: //www. enhancelink. org/ http: //www. jjay. cuny. edu/Jail_Admin Toolkit. pdf http: //www. jjay. cuny. edu/NYCMapping. Heath. Care. pdf http: //www. aidsbeacon. com/news/2010/12/03/new-point-of-service-program-willfocus-on-hiv-aids-testing-and-treatment-for-inmates-at-rikers-island/ http: //www. hcsdmass. org/

References 1. Teixeira, PA, Jordan AO, et al. Health Outcomes for HIV-Infected Persons Released from the New York City Jail System With a Transitional Health Care-Coordination Plan. AJPH. Volume 105, No. 2 pp 351 -357. Feb 2015. 2. Draine J, et al. Strategies to Enhance Linkages between Care for HIV/AIDS in Jail and Community Settings. AIDS Care, 23(3), 366 -77, 2011 3. HRSA HAB Special Projects of National Significance Program Creating a Jail Linkage Program, Training Manual and Curriculum, September 2013 www. careacttarget. org/ihip 4. Spaulding AS, et al. Jails, HIV Testing, and Linkage to Care Services: An Overview of the Enhance. Link Initiative. AIDS & Behavior. Volume 17, Issue 2 S 100 -107. 1 Oct 2013. 5. Williams CT, et al. Gender Differences in Baseline Health, Needs at Release, and Predictors of Care Engagement Among HIV-Positive Clients Leaving Jail AIDS & Behavior. Volume 17, Issue 2 S 195 -202. 1 Oct 2013. 6. Spaulding AS, et al. Planning for Success Predicts Virus Suppressed: Results of a Non. Controlled, Observational Study of Factors Associated with Viral Suppression Among HIV -Positive Persons Following Jail Release. AIDS & Behavior. Volume 17, Issue 2 Supplement, pp 203 -211. October 1, 2013. 7. Jordan AO, et al. Transitional Care Coordination in New York City Jails: Facilitating Linkages to Care for People with HIV Returning Home from Rikers Island. AIDS & Behavior. Volume 17, Issue 2 S 212 -219. 1 Oct 2013. 8. Spaulding AC, et al. Cost Analysis of Enhancing Linkages to HIV Care Following Jail: A Cost -Effective Intervention. AIDS & Behavior. Volume 17, Issue 2 S 220 -226. 1 Oct 2013.

Contact Us • Alison O. Jordan, Principal Investigator ajordan@health. nyc. gov 917 -748 -6145 • Jacqueline Cruzado-Quinones, Project Coordinator jcruzado@health. nyc. gov 917 -715 -6841 • Paul A. Teixeira, Local Evaluator pat 2007@med. cornell. edu Dripping water hollows out a stone Not through force but persistence. - Ovid

Thank you! Questions?